Category Archives: Respiratory

Tip 60: pneumothorax

Pneumothorax is more frequent in the neonatal period than at any other time in life, significantly more so in infants <1500g. The risk for pneumothorax is increased in infants with: respiratory distress syndrome meconium aspiration syndrome pulmonary hypoplasia infants who … Continue reading

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Tip 50: surfactant for RDS

Using surfactant early (<2h age vs. late) in preterm infants with RDS requiring ventilation leads to reduced: pneumothorax (RR 0.69) pulmonary interstitial emphysema (RR 0.60) neonatal mortality (RR 0.84) chronic lung disease at 36 weeks’ gestation (RR 0.69). Reference: Bahadue, F.L., … Continue reading

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Tip 49: respiratory distress syndrome (RDS)

“For babies with RDS to have the best outcomes, it is essential that they have optimal supportive care, including: maintenance of normal body temperature proper fluid management good nutritional support appropriate management of the ductus arteriosus support of the circulation to … Continue reading

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Tip 47: PEEP from the first breath

Studies have shown a ~50% reduction in surfactant administration in 25-28 week gestation babies who receive early PEEP during resuscitation/stabilisation. Also, less supplemental oxygen is required. However, the risk of pneumothorax is increased and there is no overall reduction in … Continue reading

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Tip 39: persistent pulmonary hypertension of the newborn (PPHN)

The main principles for managing persistent pulmonary hypertension of the newborn (PPHN) are: Treat & prevent hypoxia – aim pO2 ≥10 kPa and/or sats ≥95% (preductal) Treat acidosis – aim pH ≥7.35 Treat & prevent hypotension – aim BP > … Continue reading

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Tip 38: oxygenation index

The oxygenation index (OI) is useful for evaluating the degree of respiratory support a baby needs. OI = (mean airway pressure x % O2) / mmHg paO2 If using kPa as units, divide the answer above by 7.5 (as 1mmHg … Continue reading

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Tip 22b: congenital diaphragmatic hernia (CDH)

Postnatal morbidity is mainly due to pulmonary hypoplasia (depending on the amount of abdominal contents in the thorax) and persistent pulmonary hypertension of the newborn (PPHN). Postnatal survival ranges from 50 to 95%, thought to be mainly influenced by the size of the defect. References: Field D, … Continue reading

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